My Workers’ Comp Claim Is Denied,
Now What?

What to do if your workers’ comp claim is denied in South Carolina

Workers’ compensation is supposed to make it easy for workers to claim benefits after an on-the-job injury. However, employers and their insurance companies will often seek grounds for denying an injured worker’s claim for workers’ comp benefits.

Therefore, you must meticulously follow the required procedures for filing your claim. Most claims will require the assistance of an experienced workers’ compensation attorney.

What is workers’ compensation?

South Carolina’s workers’ compensation system is a no-fault insurance program for compensating workers who are injured on the job.

What this means: If you’re hurt at work, you do not have to prove that your employer was at fault for your injuries.

As a trade-off for the no-fault feature, you are prohibited from filing a personal injury lawsuit against your employer. As a result, you cannot sue your employer for punitive damages or compensation for pain and suffering.

Furthermore, while you are not required to prove your employer is at fault, you still bear the burden of proving all other elements of a workers’ compensation claim. For example, you must show that your injuries arose out of and in the course of your employment duties.

What workers’ comp benefits am I entitled to in South Carolina?

Your workers’ comp benefits include:

• Medical expenses, including doctor visits, surgeries, hospital stays, medications, rehabilitation, and medical devices and equipment
• Recovery of a portion of lost wages while you are unable to work or you must work in a limited capacity
• Death benefits to certain dependents if you die from your injuries

How do I get workers’ comp benefits?

You must comply with all statutory requirements, procedures and employer policies for claiming benefits. If you don’t, your claim may be compromised.

These are the required steps of the process:

1. Get emergency medical care immediately. This will ensure your injuries are treated and provide documentation connecting your injury to a work event.
2. Give written notice of your injury to your employer within 30 days of the accident. You have 90 days to submit your notice.
3. Consult an experienced workers’ comp lawyer. It’s best to consult a lawyer before you submit your written notice to your employer, if possible.
4. Your employer must file your claim with the Workers’ Compensation Commission. If they fail to do so, you can file the claim yourself.
5. Your employer’s insurance company will investigate and evaluate your claim. They will then render a determination of your benefits.

Can my employer deny my workers’ comp claim?

Some employers have a policy of denying workers’ compensation claims if even the slightest grounds exist. Since most South Carolina employers cover their obligations with insurance, it’s not uncommon for these 2 parties (the employer and their insurance company) to have an aversion to paying claims.

From the insurance carrier’s standpoint, they are in the business of making a profit. When they pay out claims, it diminishes their profits and taxes their statutory required reserves.

From the employer’s standpoint, payment of claims increases their insurance premiums.

Common excuses for denying workers’ comp claims

The most frequent excuse given for an employer’s claim denial is that a worker’s injury or illness did not arise out of and in the course of the worker’s job duties.

Another common excuse is that the claimant did not follow the specific procedures for filing their claim. For example,

• You didn’t timely report your injury to your employer.
• You didn’t get your medical treatment from an employer-approved medical professional.
• You didn’t get medical treatment at all.
• You didn’t file your claim on time.

Other grounds for denial:

• You are not an eligible employee. For example, you’re an independent contractor.
• You were intoxicated or using illegal drugs while on the job.
• You contributed to your injury with your horseplay or other negligent behavior.
• Your injury was a pre-existing condition.

The denial excuses given by your employer or their insurance company may or may not have merit. Unfortunately, in most cases, you will have the burden of proving that they lack merit.

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What are my rights if my workers’ comp claim is denied?

When you file your notice to your employer, the 1st arbiter of your claim is your employer and/or their insurance company. They will do the following:

• Investigate the circumstances of your injury
• Evaluate your damages
• Issue a determination of your benefits or deny your claim

If your claim is denied or your award is not sufficient, you may ask for a hearing with the South Carolina Workers’ Compensation Commission. That can take months before a hearing is set. During that time, you may be enduring onerous medical costs and lost wages.

Your first Commission hearing will be held before a single commissioner. If they do not render a satisfactory decision, you may request a hearing before the full Commission. That appeal must be filed within 14 days with the payment of a $150 fee.

If the full Commission also denies your claim or renders an insufficient benefit award, you can appeal the Commission’s judgment.

Your first venue for appeal is the South Carolina Court of Appeals. That appeal must be filed within 30 days after you receive notice of the Commission’s decision.

Your last resort for relief is an appeal to the South Carolina Supreme Court.

How a workers’ compensation lawyer can help

The process of claiming workers’ compensation can be complicated and replete with opportunities for mistakes that compromise your claim. Therefore, you must retain an experienced workers’ comp lawyer to ensure your rights are protected.

The best work injury attorney will be highly skilled in the law. Moreover, they will have extensive experience dealing with employers and their insurance companies. They should also have a working knowledge of medical issues typically associated with workers’ compensation claims.

Contact a South Carolina workers’ compensation attorney

Employers are ready to deny workers’ comp claims wherever they can. Workers’ compensation systems purportedly ease the complexity of claiming damages for workers injured on the job. In fact, a claimant still has hurdles to overcome.

Except for relief from the burden of proving employer fault, an injured worker still must prove several elements for a successful claim.

If you have the misfortune of a workplace injury or illness, you should engage the services of an experienced workers’ comp attorney. A workers’ compensation claim faces many pitfalls starting early in the process. A mistake can give your employer a reason to deny your claim. Therefore, you should get skilled legal advice as soon as possible.

If you’re injured on the job in South Carolina, contact the experienced workers’ compensation attorneys at Chappell, Chappell and Newman. Our attorneys have recovered millions of dollars for injured workers across the state of South Carolina, and we’d love the opportunity to help you, too.

Contact us today for your free consultation.